Behavioral Therapist Quotes

I have come to feel that the only learning which significantly influences behavior is self-discovered, self-appropriated learning.

The conviction grows in me that we shall discover laws of personality and behavior which are as significant for human progress or human understanding as the law of gravity or the laws of thermodynamics.

Fear and anxiety affect decision making in the direction of more caution and risk aversion... Traumatized individuals pay more attention to cues of threat than other experiences, and they interpret ambiguous stimuli and situations as threatening (Eyesenck, 1992), leading to more fear-driven decisions. In people with a dissociative disorder, certain parts are compelled to focus on the perception of danger. Living in trauma-time, these dissociative parts immediately perceive the present as being "just like" the past and "emergency" emotions such as fear, rage, or terror are immediately evoked, which compel impulsive decisions to engage in defensive behaviors (freeze, flight, fight, or collapse). When parts of you are triggered, more rational and grounded parts may be overwhelmed and unable to make effective decisions.

Someone's got to do some more research, but I would really like to know: when a CBT therapist really gets distressed, who does he go see?

The distance between your knowledge of truth and your obedience is called lack of integrity. And the amount of negative behavior--or lack of integrity--a person exhibits is directly proportional to their amount of pain." - Tara Leigh's therapist (p.118)

It seems to me that anything that can be taught to another is relatively inconsequential, and has little or no significant influence on behavior.

The borderline Queen experiences what therapists call "oral greediness". The desperate hunger of the borderline Queen is akin to the behavior of an infant who had gone too long between feelings. Starved, frustrated, and beyond the ability to calm of soothe herself, she grabs, flails, and wails until at last the nipple is planted securely and perhaps too deeply in her mouth. She coughs, gags, chokes, and spits, eyeing the elusive breast like a wolf guarding her food. Similarity, the Queen holds on to what is hers, taking more than she could use, in case it might be taken away prematurely.

Changes in Meaning: Finally, chronically traumatized people lose faith that good things can happen and people can be kind and trustworthy. They feel hopeless, often believing that the future will be as bad as the past, or that they will not live long enough to experience a good future. People who have a dissociative disorder may have different meanings in various dissociative parts. Some parts may be relatively balanced in their worldview, others may be despairing, believing the world to be a completely negative, dangerous place, while other parts might maintain an unrealistic optimistic outlook on life

If a child stays quiet in the context of extroverted friends, or even prefers time alone, a parent may worry and even send her to therapy. She might be thrilled— she’ll finally get to talk about the stuff she cares about, and without interruption! But if the therapist concludes that the child has a social phobia, the treatment of choice is to increasingly expose her to the situations she fears. This behavioral treatment is effective for treating phobias — if that is truly the problem. If it’s not the problem, and the child just likes hanging out inside better than chatting, she’ll have a problem soon. Her “illness” now will be an internalized self-reproach: “Why don’t I enjoy this like everyone else?” The otherwise carefree child learns that something is wrong with her. She not only is pulled away from her home, she is supposed to like it. Now she is anxious and unhappy, confirming the suspicion that she has a problem.

In my deepest contacts with individuals in therapy, even those whose troubles are most disturbing, whose behavior has been most anti-social, whose feelings seem most abnormal, I find this to be true. When I can sensitively understand the feelings which they are expressing, when I am able to accept them as separate persons in their own right, then I find that they tend to move in certain directions. And what are these directions in which they tend to move? The words which I believe are most truly descriptive are words such as positive, constructive, moving toward self-actualization, growing toward maturity, growing toward socialization.

Alterations in regulation of affect (emotion) and impulse: Almost all people who are seriously traumatized have problems in tolerating and regulating their emotions and surges or impulses. However, those with complex PTSD and dissociative disorders tend to have more difficulties than those with PTSD because disruptions in early development have inhibited their ability to regulate themselves. The fact that you have a dissociative organization of your personality makes you highly vulnerable to rapid and unexpected changes in emotions and sudden impulses. Various parts of the personality intrude on each other either through passive influence or switching when your under stress, resulting in dysregulation. Merely having an emotion, such as anger, may evoke other parts of you to feel fear or shame, and to engage in impulsive behaviors to stop avoid the feelings.

We are playwrights in that we spontaneously compose and direct dialogue, acting out various roles of a nurturer, an authority, or a character from a client's life.

I also think that human behavior is so mysterious and unpredictable that if you are not humble about it you are bound to be insensitive to a lot of the dilemmas and predicaments that people are facing.

I shake out my hands. I stretch my neck muscles. I let go of every single behavioral therapist's words. The ticks they made me suppress, the instincts they said I needed to relearn, I lean into all of them. Then I run. Full force and full speed.

Specific parts of you personality may be angry and are usually easily evoked. because these parts are dissociated, anger remains an emotion that is not integrated for you as a whole person. Even though individuals with dissociative disorder are responsible for their behavior, just like everyone else, regardless of which part may be acting, they may feel little control of these raging parts of themselves. Some dissociative parts may avoid or even be phobic of anger. They may influence you as a whole person to avoid conflict with others at any cost or to avoid setting healthy boundaries out of fear of someone else’s anger; or they may urge you to withdraw from others almost completely.

As you recover, you will feel more conscious of your surroundings. Freed from the ‘fog’ of your pain, fear, and confusion, you will awaken and see the world revealed as never before. You will begin to observe things, especially yourself. You will be aware of what you do and why you do it. You will begin to observe your own behavior and attitudes.

Too often the survivor is seen by [himself or] herself and others as "nuts," "crazy," or "weird." Unless her responses are understood within the context of trauma. A traumatic stress reaction consists of *natural* emotions and behaviors in response to a catastrophe, its immediate aftermath, or memories of it. These reactions can occur anytime after the trauma, even decades later. The coping strategies that victims use can be understood only within the context of the abuse of a child. The importance of context was made very clear many years ago when I was visiting the home of a Holocaust survivor. The woman's home was within the city limits of a large metropolitan area. Every time a police or ambulance siren sounded, she became terrified and ran and hid in a closet or under the bed. To put yourself in a closet at the sound of a far-off siren is strange behavior indeed—outside of the context of possibly being sent to a death camp. Within that context, it makes perfect sense. Unless we as therapists have a good grasp of the context of trauma, we run the risk of misunderstanding the symptoms our clients present and, hence, responding inappropriately or in damaging ways.

The concept of “cure” is entirely inappropriate, since in most of these disorders we are dealing with learned behavior, not with a disease.

So many of our destructive behaviors take root in an emotional void, an emptiness that calls out for something to fill it.

repeated what a cognitive behavioral therapist once told me to repeat in difficult situations: “This is the moment I find myself in.

Somehow the disorder hooks into all kinds of fears and insecurities in many clinicians. The flamboyance of the multiple, her intelligence and ability to conceptualize the disorder, coupled with suicidal impulses of various orders of seriousness, all seem to mask for many therapists the underlying pain, dependency, and need that are very much part of the process. In many ways, a professional dealing with a multiple in crisis is in the same position as a parent dealing with a two-year-old or with an adolescent's acting-out behavior. (236)

Time and again, I have asked myself why therapy works for some people while others remain the prisoners of their symptoms despite years of analysis or therapeutic care. In each and every case I examined, I was able to establish that when people found the kind of therapeutic care and companionship that enabled them to discover their own story and give free expression to their indignation at their parents’ behavior, they were able to liberate themselves from the maltreated child’s destructive attachment. As adults they were able to take their lives into their own hands and did not need to hate their parents. The opposite was the case with people whose therapists enjoined them to forgive and forget, actually believing that such forgiveness could have a salutary, curative effect. They remained trapped in the position of small children who believe they love their parents but in fact allow themselves to be controlled all their lives by the internalized parents and ultimately develop some kind of illness that leads to premature death. Such dependency actively fosters the hatred that, though repressed, remains active, and it drives them to direct their aggression at innocent people. We only hate as long as we feel totally powerless. I

One of the survival mechanisms of children raised in alcoholic families is an awareness of parental needs and feelings and of changes in parental moods and behavior. The Adult Child often makes a full-time occupation of mind reading with partners, friends, employers, and therapists. As a consequence, they earn a Ph.D. at the age of six in observing the behavior of others and assessing parental needs—but are in elementary school at age thirty, trying to learn to assess, label, or communicate their own needs and feelings.

In projecting onto others their own moral sense, therapists sometimes make terrible errors. Child physical abusers are automatically labeled “impulsive," despite extensive evidence that they are not necessarily impulsive but more often make thinking errors that justify the assaults. Sexual and physical offenders who profess to be remorseful after they are caught are automatically assumed to be sincere. After all, the therapist would feel terrible if he or she did such a thing. It makes perfect sense that the offender would regret abusing a child. People routinely listen to their own moral sense and assume that others share it. Thus, those who are malevolent attack others as being malevolent, as engaging in dirty tricks, as being “in it for the money,“ and those who are well meaning assume others are too, and keep arguing logically, keep producing more studies, keep expecting an academic debate, all the time assuming that the issue at hand is the truth of the matter. Confessions of a Whistle-Blower: Lessons Learned Author: Anna C. Salter. Ethics & Behavior, Volume 8, Issue 2 June 1998 p122

She isn't feeling easy with any of this. She doesn't know quite what to do with Bigend's proposition, which has kicked her into one of those modes that her therapist, when she last had one, would lump under the rubric of 'old behaviors.' It consisted of saying no, but somehow not quite forcefully enough, and then continuing to listen. With the result that her 'no' could be gradually chipped away at, and turned into a 'yes' before she herself was consciously aware that this was happening. She had thought she had been getting much better around this, but now she feels it happening again.

It will be implied that this goal is "normal", but it may really be the goal of being like them or like the majority of people, ignoring differences in temperament. A good cognitive-behavioral therapist, however, will be attuned to individual differences...

When clients relinquish symptoms, succeed in achieving a personal goal, or make healthier choices for themselves, subsequently many will feel anxious, guilty, or depressed. That is, when clients make progress in treatment and get better, new therapists understandably are excited. But sometimes they will also be dismayed as they watch the client sabotage her success by gaining back unwanted weight or missing the next session after an important breakthrough and deep sharing with the therapist. Thus, loyalty and allegiance to symptoms—maladaptive behaviors originally developed to manage the “bad” or painfully frustrating aspects of parents—are not maladaptive to insecurely attached children. Such loyalty preserves “object ties,” or the connection to the “good” or loving aspects of the parent. Attachment fears of being left alone, helpless, or unwanted can be activated if clients disengage from the symptoms that represent these internalized “bad” objects (for example, if the client resolves an eating disorder or terminates a problematic relationship with a controlling/jealous partner). The goal of the interpersonal process approach is to help clients modify these early maladaptive schemas or internal working models by providing them with experiential or in vivo re-learning (that is, a “corrective emotional experience”). Through this real-life experience with the therapist, clients learn that, at least sometimes, some relationships can be different and do not have to follow the same familiar but problematic lines they have come to expect.

Cognitive behavioral therapists treat trauma patients by exposing them to the things they find upsetting (at first in small ways, such as imagining them or looking at pictures), activating their fear, and helping them habituate (grow accustomed) to the stimuli.

Learning to wear a mask (that word already embedded in the term "masculinity") is the first lesson in patriarchal masculinity a boy learns. He learns that his core feelings cannot be expressed if they do not conform to the acceptable behaviors sexism defines as male. Asked to give up the true self in order to realize the patriarchal ideal, boys learn self-betrayal early and are rewarded for these acts of soul murder. Therapist John Bradshaw explains the splitting that takes place when a child learns that the way he organically feels is not acceptable. In response to this lesson that his true self is inappropriate and wrong, the boy learns to don a false self. Bradshaw explains, "The feeling that I have done something wrong, that I really don't know what it is, that there's something terribly wrong with my very being, leads to a sense of utter hopelessness. This hopelessness is the deepest cut of the mystified state. It means there is no possibility for me as I am; there is no way I can matter or be worthy of anyone's love as long as I remain myself. I must find a way to be someone else - someone who is lovable. Someone who is not me.

Children make studies of their parents, decipher them, propose theories about their behavior, turn them this way and that, examining every flaw, and continue to do so long after the parents themselves are gone. In stories, at the therapist's office, at holidays--the story of the parent never ends.

Until very recently, most mental-health practitioners believed that personality disorders were incurable because unlike mood disorders, such as depression and anxiety, personality disorders consist of long-standing, pervasive patterns of behavior that are very much a part of one’s personality. In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are ego-dystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.

Is pathological anxiety a medical illness, as Hippocrates and Aristotle and modern pharmacologists would have it? Or is it a philosophical problem, as Plato and Spinoza and the cognitive-behavioral therapists would have it? Is it a psychological problem, a product of childhood trauma and sexual inhibition, as Freud and his acolytes would have it? Or is it a spiritual condition, as Søren Kierkegaard and his existentialist descendants claimed? Or, finally, is it—as W. H. Auden and David Riesman and Erich Fromm and Albert Camus and scores of modern commentators have declared—a cultural condition, a function of the times we live in and the structure of our society?

Covert narcissists are likable to the outside world; they appear to be giving, humble, and kind. It is usually only the person who gets to know them intimately who sees the destructive traits. The rest of the world sees the façade, the “nice guy.” Many therapists don’t see through the mask and indeed are often impressed with how kind and aware the CN is. CNs seem to intensify their behavior around middle age; they rarely change because narcissists blame others and they usually don’t think they have a problem.

Fortunately analysis is not the only way to resolve inner conflicts. Life itself still remains a very effective therapist. Experience of any one of a number of kinds may be sufficiently telling to bring about personality changes. It may be the inspiring example of a truly great person; it may be a common tragedy which by bringing the neurotic in close touch with others takes him out of his egocentric isolation; it may be association with persons so congenial that manipulating or avoiding them appears less necessary. In other instances the consequences of neurotic behavior may be so drastic or of such frequent occurrence that they impress themselves on the neurotic's mind and make him less fearful and less rigid.

The seduction of women - including feminists - into confusion by Dionysian boundary violation happens under a variety of circumstances. A comment element seems to be an invitation to "freedom". The feminine Dionysian male guru or therapist invites women to spiritual or sexual liberation, at the cost of loss of Self in male-dicated behavior. Male propagation of the idea that men, too are feminine - particularly through feminine behavior by males - distracts attention from the fact that femininity is a man-made construct, having essentially nothing to do with femaleness.

Behavioral Therapy Behavioral therapy differs dramatically from classical psychoanalysis. Instead of dealing with an individual’s thoughts, feelings, and past experiences, it focuses solely on the specific behaviors that are causing problems. Behavioral therapists believe that all behaviors are learned and that you can relearn and replace maladaptive behaviors with more appropriate ones.

For example, in order to identify these schemas or clarify faulty relational expectations, therapists working from an object relations, attachment, or cognitive behavioral framework often ask themselves (and their clients) questions like these: 1. What does the client tend to want from me or others? (For example, clients who repeatedly were ignored, dismissed, or even rejected might wish to be responded to emotionally, reached out to when they have a problem, or to be taken seriously when they express a concern.) 2. What does the client usually expect from others? (Different clients might expect others to diminish or compete with them, to take advantage and try to exploit them, or to admire and idealize them as special.) 3. What is the client’s experience of self in relationship to others? (For example, they might think of themselves as being unimportant or unwanted, burdensome to others, or responsible for handling everything.) 4. What are the emotional reactions that keep recurring? (In relationships, the client may repeatedly find himself feeling insecure or worried, self-conscious or ashamed, or—for those who have enjoyed better developmental experiences—perhaps confident and appreciated.) 5. As a result of these core beliefs, what are the client’s interpersonal strategies for coping with his relational problems? (Common strategies include seeking approval or trying to please others, complying and going along with what others want them to do, emotionally disengaging or physically withdrawing from others, or trying to dominate others through intimidation or control others via criticism and disapproval.) 6. Finally, what kind of reactions do these interpersonal styles tend to elicit from the therapist and others? (For example, when interacting together, others often may feel boredom, disinterest, or irritation; a press to rescue or take care of them in some way; or a helpless feeling that no matter how hard we try, whatever we do to help disappoints them and fails to meet their need.)

A general principle of human behavior is that it’s easier for us to see something negative in other people than in ourselves. This mental process sometimes guides therapists when they make interpretations during treatment. Often, the traits that disturb us most in others are those that we ourselves possess. It may upset us to see these qualities in other people, but it’s completely unacceptable to acknowledge them in ourselves.

... the silent client may be experienced as withholding, oppositional, and sulking or as holding the therapist "hostage" in ways that elicit resentment and other negative responses. Because it is not unusual that relational and other forms of traumatization began when the client was preverbal, he or she may not have words. The lack of access to emotions or to words to describe them is known as alexithymia and is a common response to trauma. What the client is likely to have instead is somatosensory, behavioral, dissociative, and relational manifestations that therapists must seek to understand and translate into words, a process that involves hard work and intense focus.

Emotions are seen as crucial in motivating behavior. People generally do what they feel like doing rather than what reason or logic dictates. It follows that to achieve behavioral change, people need to change the emotions motivating their behavior. Emotion also influences thought. When people feel angry, they think angry thoughts; when they are sad, they recall sad memories. To help people change what they think, therapists must help them change what they feel.

The drug dealer, the ducking and diving political leader, the wife beater, the chronically “crabby” boss, the “hot shot” junior executive, the unfaithful husband, the company “yes man,” the indifferent graduate school adviser, the “holier than thou” minister, the gang member, the father who can never find the time to attend his daughter’s school programs, the coach who ridicules his star athletes, the therapist who unconsciously attacks his clients’ “shining” and seeks a kind of gray normalcy for them, the yuppie—all these men have something in common. They are all boys pretending to be men. They got that way honestly, because nobody showed them what a mature man is like. Their kind of “manhood” is a pretense to manhood that goes largely undetected as such by most of us. We are continually mistaking this man’s controlling, threatening, and hostile behaviors for strength. In reality, he is showing an underlying extreme vulnerability and weakness, the vulnerability of the wounded boy.

Whereas we’d once believed that the symptoms and behavior exhibited by our clients primarily reflected their psychological defenses—a view that attributed a degree of intentionality, no matter how unconscious—now, we better understood the symptoms as manifestations of instinctive brain and bodily survival responses. We understood that sympathetic activation fuels anxiety and rage, parasympathetic dominance causes shutdown and passive-aggressive behavior, flight responses spur fleeing the therapist’s office, and fight responses lead to verbal or physical aggression or violence turned against the self. When clients self-harm, for example, these days, we understand their actions to be instinctive, rather than thought out—an effort to regulate or relieve, rather than punish.

Cognitive Therapy Instead of behavior, cognitive therapy emphasizes changing thoughts and beliefs. Cognitive therapists believe that irrational beliefs or distorted thinking patterns lead to social anxiety so they teach patients to think in more rational, constructive ways.

You are not a hot mess or hopeless cause just because you're scared or out of sorts. We cannot hang up on the call for courage that speed dials us every day. If facing the simultaneous brokenness and possibility of living were easy, we wouldn't need therapists, besties, teachers, scientists, coaches, healers, artists, and comedians nudging us to critically think, take agency, be more self-compassionate, see our humanity, and stop taking ourselves and our so-called "failures" so seriously. "Failure" is how we learn and grow. Community and solidarity are how we heal.

This work led cognitive therapists such as Aaron Beck, David D. Burns, and Albert Ellis to build treatment around the idea that our thoughts shape our emotions, not the other way around. By changing our thinking, we can alleviate depression or simply have greater control over our behavior.

Our inner experience is that which we think, feel, remember, perceive, sense, decide, plan and predict. These experiences are actually mental actions, or mental activity (Van der Hart et al., 2006). Mental activity, in which we engage all the time, may or may not be accompanied by behavioral actions. It is essential that you become aware of, learn to tolerate and regulate, and even change major mental actions that affect your current life, such as negative beliefs, and feelings or reactions to the past the interfere with the present. However, it is impossible to change inner experiences if you are avoiding them because you are afraid, ashamed or disgusted by them. Serious avoidance of you inner experiences is called experiential avoidance (Hayes, Wilson, Gifford, & Follettte, 1996), or the phobia of inner experience (Steele, Van der Hart, & Nijenhuis, 2005; Van der Hart et al., 2006).

Replace Behaviors That Make Your Rumination and Worry Worse There’s not much point in using strategies to decrease rumination and worry if you’re concurrently adding fuel to those fires. Self-criticism is one kind of fuel. Other types of fuel include things like excessive reassurance seeking, spending hours looking up health information online, or compulsively looking at your ex’s Facebook page. Look out for behaviors that seem to provide a temporary reprieve from anxiety but, in fact, make you feel like you need to go back and repeat them. Look into seeing a cognitive behavioral therapist if you can’t stop those behaviors on your own.

short term always leaves us in a place worse off than when we started. — To properly heal from addiction, we need a holistic approach. We need to create a life we don’t need to escape. We need to address the root causes that made us turn outside ourselves in the first place. This means getting our physical health back, finding a good therapist, ending or leaving abusive relationships, learning to reinhabit our bodies, changing our negative thought patterns, building support networks, finding meaning and connecting to something greater than ourselves, and so on. To break the cycle of addiction, we need to learn to deal with cravings, break old habits, and create new ones. To address all of this is an overwhelming task, but there is a sane, empowering, and balanced approach. But before we discuss how to implement solutions to the Two-Part Problem, we need to address one of the bigger issues that women and other historically oppressed folks need to consider, which is how patriarchal structures affect the root causes of addiction, how they dominate the recovery landscape, and what that means for how we experience recovery. If we are sick from sexism, homophobia, racism, classism, microaggressions, misogyny, ableism, American capitalism, and so on—and we are—then we need to understand how recovery frameworks that were never built with us in mind can actually work against us, further pathologizing characteristics, attributes, and behaviors that have been used to keep us out of our power for millennia. We need to examine what it means for us individually and collectively when a structure built by and for upper-class white men in the early twentieth century dominates the treatment landscape.

He changes his perception of himself, becoming more realistic in his views of self. He becomes more like the person he wishes to be. He values himself more highly. He is more self-confident and self-directing. He has a better understanding of himself, becomes more open to his experience, denies or represses less of his experience. He becomes more accepting in his attitudes toward others, seeing others as more similar to himself. In his behavior he shows similar changes. He is less frustrated by stress, and recovers from stress more quickly. He becomes more mature in his everyday behavior as this is observed by friends. He is less defensive, more adaptive, more able to meet situations creatively.

We are offered glimpses, even deep searches, into the questions that haunt people the most. We experience a level of intimacy with our clients that few will ever know. We are exposed to levels of drama and emotional arousal that are at once terrifying and captivating. We get to play detective and help solve mysteries that have plagued people throughout their lives. We hear stories so amazing that they make television shows, novels, and movies seem tedious and predictable by comparison. We become companions to people who are on the verge of making significant changes— and we are transformed as well. We go to sleep at night knowing that, in some way, we have made a difference in people’s lives. There is almost a spiritual transcendence associated with much of the work we do.

In other words, if you don’t act as your own therapist, and interrogate your own childhood, you won’t be the best parent you can be. A parental perspective allows you to understand the challenges your parents faced that you might not have recognized as a child. A child’s perspective is myopic, and it’s impossible for us as children to understand all the factors that influence our parents’ behavior.

It is common to hear people (especially counselors or therapists) say things like “feelings are always valid.” What this usually means is that if a person feels a certain way, he or she feels that way for a reason. The feelings may be in reaction to faulty data, but the fact is that the person feels what she or he feels, wants what she or he wants, thinks what she or he thinks. It just is what it is.

Acceptance in the context of adult-to-adult relationships may mean simply acknowledging that the other is the way he or she is, not judging them and not corroding one’s own soul with resentment that they are not different. Acceptance does not mean saintly self-sacrifice or tolerating an eternity of broken promises and hurtful eruptions of frustration and rage. Sometimes a person remains with an addicted partner for fear of the guilt they might experience otherwise. A therapist once said to me, “When it comes to a choice between feeling guilt or resentment, choose the guilt every time.” It is wisdom I have passed on to many others since. If refusal to take on responsibility for another person’s behaviors burdens you with guilt, while consenting to it leaves you eaten by resentment, opt for the guilt. Resentment is soul suicide.

My own odyssey of therapy, over my forty-five-year career, is as follows: a 750-hour, five-time-a-week orthodox Freudian psychoanalysis in my psychiatric residency (with a training analyst in the conservative Baltimore Washington School), a year’s analysis with Charles Rycroft (an analyst in the “middle school” of the British Psychoanalytic Institute), two years with Pat Baumgartner (a gestalt therapist), three years of psychotherapy with Rollo May (an interpersonally and existentially oriented analyst of the William Alanson White Institute), and numerous briefer stints with therapists from a variety of disciplines, including behavioral therapy, bioenergetics, Rolfing, marital-couples work, an ongoing ten-year (at this writing) leaderless support group of male therapists, and, in the 1960s, encounter groups of a whole rainbow of flavors, including a nude marathon group.

This is the same stuff your parents did to you: ignoring your feelings, not recognizing what you needed, invalidating you. You grew up never being taught how to be honest about what was going on inside you. You also had to pretend.” “So now you have blame them too? It this what therapy does—teaches you to blame and hurt others to make yourself feel better?” “I don’t see why we can’t look at the facts without judging them. No one ever talked about what was really going on in our family. We were always hiding, or ignoring, or punishing when things came to the surface.” “That was years ago! If you can’t let go of the past, then I don’t think you’re making all that much progress. And you can tell your therapist that.” She’s waving frantically at the waiter to give her the check, even though our dinner is only half eaten. “Just go…” she hisses, not looking at me any more, fumbling for her purse. “Just leave.

I resolved to come right to the point. "Hello," I said as coldly as possible, "we've got to talk." "Yes, Bob," he said quietly, "what's on your mind?" I shut my eyes for a moment, letting the raging frustration well up inside, then stared angrily at the psychiatrist. "Look, I've been religious about this recovery business. I go to AA meetings daily and to your sessions twice a week. I know it's good that I've stopped drinking. But every other aspect of my life feels the same as it did before. No, it's worse. I hate my life. I hate myself." Suddenly I felt a slight warmth in my face, blinked my eyes a bit, and then stared at him. "Bob, I'm afraid our time's up," Smith said in a matter-of-fact style. "Time's up?" I exclaimed. "I just got here." "No." He shook his head, glancing at his clock. "It's been fifty minutes. You don't remember anything?" "I remember everything. I was just telling you that these sessions don't seem to be working for me." Smith paused to choose his words very carefully. "Do you know a very angry boy named 'Tommy'?" "No," I said in bewilderment, "except for my cousin Tommy whom I haven't seen in twenty years..." "No." He stopped me short. "This Tommy's not your cousin. I spent this last fifty minutes talking with another Tommy. He's full of anger. And he's inside of you." "You're kidding?" "No, I'm not. Look. I want to take a little time to think over what happened today. And don't worry about this. I'll set up an emergency session with you tomorrow. We'll deal with it then." Robert This is Robert speaking. Today I'm the only personality who is strongly visible inside and outside. My own term for such an MPD role is dominant personality. Fifteen years ago, I rarely appeared on the outside, though I had considerable influence on the inside; back then, I was what one might call a "recessive personality." My passage from "recessive" to "dominant" is a key part of our story; be patient, you'll learn lots more about me later on. Indeed, since you will meet all eleven personalities who once roamed about, it gets a bit complex in the first half of this book; but don't worry, you don't have to remember them all, and it gets sorted out in the last half of the book. You may be wondering -- if not "Robert," who, then, was the dominant MPD personality back in the 1980s and earlier? His name was "Bob," and his dominance amounted to a long reign, from the early 1960s to the early 1990s. Since "Robert B. Oxnam" was born in 1942, you can see that "Bob" was in command from early to middle adulthood. Although he was the dominant MPD personality for thirty years, Bob did not have a clue that he was afflicted by multiple personality disorder until 1990, the very last year of his dominance. That was the fateful moment when Bob first heard that he had an "angry boy named Tommy" inside of him. How, you might ask, can someone have MPD for half a lifetime without knowing it? And even if he didn't know it, didn't others around him spot it? To outsiders, this is one of the most perplexing aspects of MPD. Multiple personality is an extreme disorder, and yet it can go undetected for decades, by the patient, by family and close friends, even by trained therapists. Part of the explanation is the very nature of the disorder itself: MPD thrives on secrecy because the dissociative individual is repressing a terrible inner secret. The MPD individual becomes so skilled in hiding from himself that he becomes a specialist, often unknowingly, in hiding from others. Part of the explanation is rooted in outside observers: MPD often manifests itself in other behaviors, frequently addiction and emotional outbursts, which are wrongly seen as the "real problem." The fact of the matter is that Bob did not see himself as the dominant personality inside Robert B. Oxnam. Instead, he saw himself as a whole person. In his mind, Bob was merely a nickname for Bob Oxnam, Robert Oxnam, Dr. Robert B. Oxnam, PhD.

But another type of life review happens to all of us when we die and our consciousness leaves the physical body at the end of each lifetime. This time it is not done with a therapist, but rather with our spiritual guides or other wise beings; it is not a clinical life review but a karmic one. As we are replenished by the beautiful light, our awareness is directed to review the results of our actions while we were on the physical plane. We see the people we have harmed and we feel their emotional reactions, magnified greatly. Similarly, we feel the emotions, again enhanced, of those we have aided and loved. In this manner, we examine all our relationships, and we deeply experience all the anger, hurt, and despair that we have caused—but also all the gratitude, appreciation, love, and hope that we have elicited. This life review is not done in a spirit of punishment or guilt. By truly understanding the result of our behavior, we learn the importance of loving-kindness and compassion. As

In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are egodystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.

...but if the result of my efforts and those of others is that man becomes a robot, created and controlled by a science of his own making, then I am very unhappy indeed. If the good life of the future consists in so conditioning individuals through the control of their environment, and through the control of the rewards they receive, that they will be inexorably productive, well-behaved, happy or whatever, then I want none of it. To me this is a pseudo-form of the good life which includes everything save that what makes it good.

The overarching principle of a therapeutic relationship is that therapists should be ever mindful of a variant of the Hippocratic oath and, to the degree possible, strive to "do no more harm" (Courtois, 2010). Complex trauma clients have already experienced considerable harm, much of it at the hands of other human beings. As a result of the ubiquitous processes of transference, attachment styles, and IWM [Internal working models], these clients often view the therapist's behavior and their relationship through the lens of their trauma-related negative interpersonal expectancies and unhealed emotional wounds and injuries. Therapists should not be surprised to be "guilty until proven innocent", not because clients with complex trauma histories are "unfair" or "unreasonable" but precisely the opposite - because the most realistic self-protective stance for them (given the fact that betrayal and harm have been more the rule than the exception) is to "distrust first and verify" (or to be hypervigilant) rather than to start with an expectation of safety and trustworthiness.

Freedom to be oneself is a frighteningly responsible freedom, arid an individual moves toward it cautiously, fearfully, and with almost no confidence at first... To be responsibly self-directing means that one chooses—and then learns from the consequences. So clients find this a sobering but exciting kind of experience. As one client says—“I feel frightened, and vulnerable, and cut loose from support, but I also feel a sort of surging up or force or strength in me.” This is a common kind of reaction as the client takes over the self-direction of his own life and behavior.

If all that is not confusing enough, we also use the word love to explain behavior. “I did it because I love her.” That explanation is given for all kinds of actions. A politician is involved in an adulterous relationship, and he calls it love. The preacher, on the other hand, calls it sin. The wife of an alcoholic picks up the pieces after her husband’s latest episode. She calls it love, but the psychologist calls it codependency. The parent indulges all the child’s wishes, calling it love. The family therapist would call it irresponsible parenting. What is loving behavior?

Most of us come to therapy feeling trapped—imprisoned by our thoughts, behaviors, marriages, jobs, fears, or past. Sometimes we imprison ourselves with a narrative of self-punishment. If we have a choice between believing one of two things, both of which we have evidence for—I’m unlovable, I’m lovable—often we choose the one that makes us feel bad. Why do we keep our radios tuned to the same static-ridden stations (the everyone’s-life-is-better-than-mine station, the I-can’t-trust-people station, the nothing-works-out-for-me station) instead of moving the dial up or down? Change the station. Walk around the bars. Who’s stopping us but ourselves?

Couples counseling has long been banned from the list of acceptable treatments for domestic violence . . . "an inappropriate intervention that further endangers the woman." Schechter explained: 'It encourages the abuser to blame the victim by examining her "role" in his problem. By seeing the couple together, the therapist erroneously suggests that the partner, too, is responsible for the abuser's behavior. Many women have been beaten brutally following couples counseling sessions in which they disclosed violence or coercion. The abuser alone must take responsibility for the assaults and understand that family reunification is not his treatment goal; the goal is to stop the violence.

Humans never outgrow their need to connect with others, nor should they, but mature, truly individual people are not controlled by these needs. Becoming such a separate being takes the whole of a childhood, which in our times stretches to at least the end of the teenage years and perhaps beyond. We need to release a child from preoccupation with attachment so he can pursue the natural agenda of independent maturation. The secret to doing so is to make sure that the child does not need to work to get his needs met for contact and closeness, to find his bearings, to orient. Children need to have their attachment needs satiated; only then can a shift of energy occur toward individuation, the process of becoming a truly individual person. Only then is the child freed to venture forward, to grow emotionally. Attachment hunger is very much like physical hunger. The need for food never goes away, just as the child's need for attachment never ends. As parents we free the child from the pursuit of physical nurturance. We assume responsibility for feeding the child as well as providing a sense of security about the provision. No matter how much food a child has at the moment, if there is no sense of confidence in the supply, getting food will continue to be the top priority. A child is not free to proceed with his learning and his life until the food issues are taken care of, and we parents do that as a matter of course. Our duty ought to be equally transparent to us in satisfying the child's attachment hunger. In his book On Becoming a Person, the psychotherapist Carl Rogers describes a warm, caring attitude for which he adopted the phrase unconditional positive regard because, he said, “It has no conditions of worth attached to it.” This is a caring, wrote Rogers, “which is not possessive, which demands no personal gratification. It is an atmosphere which simply demonstrates I care; not I care for you if you behave thus and so.” Rogers was summing up the qualities of a good therapist in relation to her/his clients. Substitute parent for therapist and child for client, and we have an eloquent description of what is needed in a parent-child relationship. Unconditional parental love is the indispensable nutrient for the child's healthy emotional growth. The first task is to create space in the child's heart for the certainty that she is precisely the person the parents want and love. She does not have to do anything or be any different to earn that love — in fact, she cannot do anything, since that love cannot be won or lost. It is not conditional. It is just there, regardless of which side the child is acting from — “good” or “bad.” The child can be ornery, unpleasant, whiny, uncooperative, and plain rude, and the parent still lets her feel loved. Ways have to be found to convey the unacceptability of certain behaviors without making the child herself feel unaccepted. She has to be able to bring her unrest, her least likable characteristics to the parent and still receive the parent's absolutely satisfying, security-inducing unconditional love. A child needs to experience enough security, enough unconditional love, for the required shift of energy to occur. It's as if the brain says, “Thank you very much, that is what we needed, and now we can get on with the real task of development, with becoming a separate being. I don't have to keep hunting for fuel; my tank has been refilled, so now I can get on the road again.” Nothing could be more important in the developmental scheme of things.

In supportive work, the therapist cedes great control to the patient. It may seem otherwise. The therapist is setting limits, perhaps implicitly commenting on the patient's behavior or sense of self, and so forth, and on the surface it seems that the therapist is taking responsibility for the patient's progress. but all this activity leads nowhere except, if we succeed, to stability. In supportive therapy, change arises in a more or less miraculous way , through the patient's suddenly feeling secure enough to move in a certain direction, perhaps one unanticipated by the therapist. It is this pathless quality of supportive work - the degree of blind faith it requires of the therapist - that makes it most uncomfortable.

In Lost Boys therapist James Garbarino testifies that when it comes to boys, “neglect is more common than abuse: more kids are emotionally abandoned than are directly attacked, physically or emotionally.” Emotional neglect lays the groundwork for the emotional numbing that helps boys feel better about being cut off. Eruptions of rage in boys are most often deemed normal, explained by the age-old justification for adolescent patriarchal mis-behavior, “Boys will be boys.” Patriarchy both creates the rage in boys and then contains it for later use, making it a resource to exploit later on as boys become men. As a national product, this rage can be garnered to further imperialism, hatred, and oppression of women and men globally.

Dr. Louis Jolyon “Jolly” West was born in New York City on October 6, 1924. He died of cancer on January 2, 1999. Dr. West served in the U.S. Army during World War II and received his M.D. from the University of Minnesota in 1948, prior to Air Force LSD and MKULTRA contracts carried out there. He did his psychiatry residency from 1949 to 1952 at Cornell (an MKULTRA Institution and site of the MKULTRA cutout The Human Ecology Foundation). From 1948 to 1956 he was Chief, Psychiatry Service, 3700th USAF Hospital, Lackland Air Force Base, San Antonio, Texas Psychiatrist-in-Chief, University of Oklahoma Consultant in Psychiatry, Oklahoma City Veterans Administration Hospital Consultant in Psychiatry. [...] Dr. West was co-editor of a book entitled Hallucinations, Behavior, Experience, and Theory[285]. One of the contributors to this book, Theodore Sarbin, Ph.D., is a member of the Scientific and Professional Advisory Board of the False Memory Syndrome Foundation (FMSF). Other members of the FMSF Board include Dr. Martin Orne, Dr. Margaret Singer, Dr. Richard Ofshe, Dr. Paul McHugh, Dr. David Dinges, Dr. Harold Lief, Emily Carota Orne, and Dr. Michael Persinger. The connections of these individuals to the mind control network are analyzed in this and the next two chapters. Dr. Sarbin[272] (see Ross, 1997) believes that multiple personality disorder is almost always a therapist-created artifact and does not exist as a naturally-occurring disorder, a view adhered to by Dr. McHugh[188], [189], Dr. Ofshe[213] and other members of the FMSF Board[191], [243]. Dr. Ofshe is a colleague and co-author of Dr. Singer[214], who is in turn a colleague and co author of Dr. West[329]. Denial of the reality of multiple personality by these doctors in the mind control network, who are also on the FMSF Scientific and Professional Advisory Board, could be disinformation. The disinformation could be amplified by attacks on specialists in multiple personality as CIA conspiracy lunatics[3], [79], [191], [213]. The FMSF is the only organization in the world that has attacked the reality of multiple personality in an organized, systematic fashion. FMSF Professional and Advisory Board Members publish most of the articles and letters to editors of psychiatry journals hostile to multiple personality disorder.

Cognitive-Behavioral Therapy There are almost no pure cognitive or behavioral therapists. Instead, most therapists use a combination of both techniques. This is known as cognitive-behavioral therapy. It is generally recognized as the best therapy for social anxiety. In cognitive-behavioral therapy, a therapist helps you identity maladaptive thinking patterns and replace them with new ways of thinking. He or she also teaches you relaxation techniques and new behaviors that make you feel more comfortable in social situations. Cognitive-behavioral therapy uses many of the same techniques that we explored in the previous chapter. Although you might make great strides on your own, sometimes it is easier and faster to have someone guide you. Often it is difficult for people to explore hidden beliefs about themselves. A professional therapist is experienced in working with people who are trying to change. Often a therapist will see connections in your situation that you cannot. Carlos was terrified of speaking in class. Whenever the teacher called on him, his heart raced, he blushed, and his stomach felt upset. His therapist first had him focus on his thoughts during class. As an experiment, she had him purposely answer a question incorrectly during biology class. To his surprise, the teacher didn’t make a big deal out of it, and the other students didn’t laugh. As a result, Carlos realized that his imagined consequences for making errors were greatly exaggerated. He also realized that he held himself to a higher standard than other people, including the teacher, did. Next, his therapist showed him various relaxation techniques to lessen the physical symptoms of anxiety. Soon, he felt more comfortable and even volunteered to lead a discussion group.

Social Skills Training Social skills training is based on the belief that socially anxious people lack certain social skills, such as how to make small talk or introduce themselves to strangers. Therapists think that anxiety would lessen for people if they knew the correct way to behave. In social skills training, you practice techniques such as rehearsal (practicing a certain skill until it becomes comfortable), modeling (imitating others in social situations until the behavior feels natural), and role playing. You also receive homework assignments, such as “This week, talk about the weather with three strangers.” A problem with this type of therapy is that even though many people know how they should act, they can’t do it because of fear, negative thoughts, and avoidance. Although practicing social skills may take away some of the uncertainty, it doesn’t address the deeper issues.

A Final Word Now that you have become familiar with social anxiety, you know that it is a common problem, especially for teenagers. You’ve learned that it affects you physically, mentally, and behaviorally, and that it can have a tremendous impact on all aspects of your life. Most important, you’ve learned ways to cope with social anxiety. Now, make the techniques presented in this book part of your daily life. With practice you will be able to calm anxious feelings and develop self-confidence in social situations. Remember that change does not happen overnight. There will be tough times mixed in with the good. It may be necessary to see a professional therapist or to take medication. There is no reason social anxiety needs to remain a part of your life. If you are committed to lessening your anxiety, you will see great results. With time and hard work, you can become the person you want to be and live a healthy, happy, and productive life.

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

Uneducated therapists often have an inability to cope with the behaviors of persecutory alters. They commonly focus on helping one side of the personality system and battling with the other side. When “Satan” or some similar part talks in a deep scary voice to you or to the client, it is easy to think this is a nasty perpetrator or a supernatural being, and to and to oppose it or fight with it or try to banish it. However, if you do this, you will engender the hostility of this part, who has probably been very badly hurt and told a lot of lies. You will foster internal splitting in this way, and get nowhere fast. Once you recognize that these alters have a protective intent, you can see that working with them involves enlisting them in the service of healing, just as they were originally enlisted in the cause of safety. You will see examples of these kinds of errors, which often result in clients leaving their therapists, in survivor LisaBri's story: When therapists make mistakes.

When a person gives attention to unresolved issues of the past, she often must work through resistance and apprehensions. To dismantle rigid defenses, interpret unconscious motives, or reflect on unexplored feelings we must sometimes push the client to the brink of her patience and endurance. She must confront parts of herself that have been deeply buried, and she must risk the consequences of relinquishing coping strategies that have worked fairly well until this point, even with their side effects and collateral damage. There is a risk (or perhaps even a certainty) that some destabilization will occur. In order to attain real growth, the client must often be willing to experience intense confusion, disorientation, and discomfort. She leaves behind an obsolete image of herself, one that was once comfortable and familiar, and she risks not liking the person she will become. She will lose a part of herself that can never be recovered. She risks all this for the possibility of a better existence, and all she has to go on is the therapist’s word.

Some addictions are clear. The homeless woman with the fresh track marks over years of scars. The man who loses his home and car to gambling debts and now is hiding from dangerous creditors. Some addictions are softer, easier to engage in and still get up and function every day. Those of us who take out a bag of chips or tray of muffins after a tough day. Or go shoe shopping for our 8th pair of black sandals that we are never going to wear. There are addictions that excuse us from society altogether, those that keep us barely afloat within it, and those that become a barrier between us and the rest of the world. It’s only a matter of degree, in the end. How do we define when we cross over into addiction territory? As a relationally-trained therapist, my answer is a simple one. When our addiction becomes our primary relationship. Maybe not in our hearts and heads. But in our behaviors, definitely. When we don’t have control over our addictions, we are spending time, resources, and energy on the addiction instead of the people we love. And instead of, let’s face it…ourselves.

Virtually every version of CBT for anxiety disorders involves working through what’s called an exposure hierarchy. The concept is simple. You make a list of all the situations and behaviors you avoid due to anxiety. You then assign a number to each item on your list based on how anxiety provoking you expect doing the avoided behavior would be. Use numbers from 0 (= not anxiety provoking at all) to 100 (= you would fear having an instant panic attack). For example, attempting to talk to a famous person in your field at a conference might be an 80 on the 0-100 scale. Sort your list in order, from least to most anxiety provoking. Aim to construct a list that has several avoided actions in each 10-point range. For example, several that fall between 20 and 30, between 30 and 40, and so on, on your anxiety scale. That way, you won’t have any jumps that are too big. Omit things that are anxiety-provoking but wouldn’t actually benefit you (such as eating a fried insect). Make a plan for how you can work through your hierarchy, starting at the bottom of the list. Where possible, repeat an avoided behavior several times before you move up to the next level. For example, if one of your items is talking to a colleague you find intimidating, do this several times (with the same or different colleagues) before moving on. When you start doing things you’d usually avoid that are low on your hierarchy, you’ll gain the confidence you need to do the things that are higher up on your list. It’s important you don’t use what are called safety behaviors. Safety behaviors are things people do as an anxiety crutch—for example, wearing their lucky undies when they approach that famous person or excessively rehearsing what they plan to say. There is a general consensus within psychology that exposure techniques like the one just described are among the most effective ways to reduce problems with anxiety. In clinical settings, people who do exposures get the most out of treatment. Some studies have even shown that just doing exposure can be as effective as therapies that also include extensive work on thoughts. If you want to turbocharge your results, try exposure. If you find it too difficult to do alone, consider working with a therapist.

I began to see that the stronger a therapy emphasized feelings, self-esteem, and self-confidence, the more dependent the therapist was upon his providing for the patient ongoing, unconditional, positive regard. The more self-esteem was the end, the more the means, in the form of the patient’s efforts, had to appear blameless in the face of failure. In this paradigm, accuracy and comparison must continually be sacrificed to acceptance and compassion; which often results in the escalation of bizarre behavior and bizarre diagnoses. The bizarre behavior results from us taking credit for everything that is positive and assigning blame elsewhere for anything negative. Because of this skewed positive-feedback loop between our judged actions and our beliefs, we systematically become more and more adapted to ourselves, our feelings, and our inaccurate solitary thinking; and less and less adapted to the environment that we share with our fellows. The resultant behavior, such as crying, depression, displays of temper, high-risk behavior, or romantic ventures, or abandonment of personal responsibilities, which seem either compulsory, necessary, or intelligent to us, will begin to appear more and more irrational to others. The bizarre diagnoses occur because, in some cases, if a ‘cause disease’ (excuse from blame) does not exist, it has to be 'discovered’ (invented). Psychiatry has expanded its diagnoses of mental disease every year to include 'illnesses’ like kleptomania and frotteurism [now frotteuristic disorder in the DSM-V]. (Do you know what frotteurism is? It is a mental disorder that causes people, usually men, to surreptitiously fondle women’s breasts or genitals in crowded situations such as elevators and subways.) The problem with the escalation of these kinds of diagnoses is that either we can become so adapted to our thinking and feelings instead of our environment that we will become dissociated from the whole idea that we have a problem at all; or at least, the more we become blameless, the more we become helpless in the face of our problems, thinking our problems need to be 'fixed’ by outside help before we can move forward on our own. For 2,000 years of Western culture our problems existed in the human power struggle constantly being waged between our principles and our primal impulses. In the last fifty years we have unprincipled ourselves and become what I call 'psychologized.’ Now the power struggle is between the 'expert’ and the 'disorder.’ Since the rise of psychiatry and psychology as the moral compass, we don’t talk about moral imperatives anymore, we talk about coping mechanisms. We are not living our lives by principles so much as we are living our lives by mental health diagnoses. This is not working because it very subtly undermines our solid sense of self.

The development of a working alliance is crucial because it addresses a psychic phobia associated with relationships that is common in complex trauma clients. As we discussed, when primary relationships are sources of profound disillusionment, betrayal, and emotional pain, any subsequent relationship with an authority figure who offers an emotional bond or other assistance might be met with a range of emotions, such as fear, suspicion, anger, or hopelessness on the negative end of the continuum and idealization, hope, overdependence, and entitlement on the positive. Therapy offers a compensatory relationship, albeit within a professional framework, that has differences from and restrictions not found in other relationships. On the one hand, the therapist works within professional and ethical boundaries and limitations in a role of higher status and education and is therefore somewhat unattainable for the client. On the other, the therapist's ethical and professional mandate is the welfare of the client, creating a perception of an obligation to meet the client's needs and solve his or her problems. Furthermore, the therapist is expected to both respect the client's privacy and accept emotional and behavioral difficulties without judgment, while simultaneously being entitled to ask the client about his or her most personal and distressing feelings, thoughts and experiences. Developing a sense of trust in the therapist, therefore, is both expected and fraught with inherent difficulties that are amplified by each client's unique history of betrayal trauma, loss, and relational distress.

Kathy’s teachers view her as a good student who always does her homework but rarely participates in class. Her close friends see her as a loyal and trustworthy person who is a lot of fun once you get to know her. The other students in school think she is shy and very quiet. None of them realize how much Kathy struggles with everyday life. When teachers call on her in class, her heart races, her face gets red and hot, and she forgets what she wants to say. Kathy believes that people think she is stupid and inadequate. She imagines that classmates and teachers talk behind her back about the silly things she says. She makes excuses not to go to social events because she is terrified she will do something awkward. Staying home while her friends are out having a good time also upsets her. “Why can’t I just act like other people?” she often thinks. Although Kathy feels isolated, she has a very common problem--social anxiety. Literally millions of people are so affected by self-consciousness that they have difficulties in social situations. For some, the anxiety occurs during very specific events, such as giving a speech or eating in public. For others, like Kathy, social anxiety is part of everyday life. Unfortunately, social anxiety is not an easily diagnosed condition. Instead, it is often viewed as the far edge of a continuum of behaviors and feelings that occur during social situations. Although you may not have as much difficulty as Kathy, shyness may still be causing you distress, affecting your relationships, or making you act in ways with which you are not happy. If this is the case, you will benefit from the advice and techniques provided in this book. The good news is that it is possible to change your thinking and behavior. However, there are no easy solutions. It takes strong motivation and time to overcome social anxiety. It might even be necessary to see a professional therapist or take medication. Eventually, becoming free of your anxiety will make the hard work well worth the effort. This book will help you understand social anxiety and the impact it can have on your life, now and in the future. You will find out how the disorder is diagnosed, you will receive information on professional guidance, and you will learn ways to cope with and manage the symptoms. Becoming an extroverted person is probably unlikely, but you can become more confident in social situations and increase your self-esteem.

There presently exist three recognized conceptualizations of the antisocial construct: antisocial personality disorder (ASPD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), dissocial personality disorder in the International Classification of Diseases (ICD-10; World Health Organization, 1992), and psychopathy as formalized by Hare with the Psychopathy Checklist—Revised (PCL-R; Hare, 2003). A conundrum for therapists is that these conceptualizations are overlapping but not identical, emphasizing different symptom clusters. The DSM-5 emphasizes the overt conduct of the patient through a criteria set that includes criminal behavior, lying, reckless and impulsive behavior, aggression, and irresponsibility in the areas of work and finances. In contrast, the criteria set for dissocial personality disorder is less focused on conduct and includes a mixture of cognitive signs (e.g., a tendency to blame others, an attitude of irresponsibility), affective signs (e.g., callousness, inability to feel guilt, low frustration tolerance), and interpersonal signs (e.g., tendency to form relationships but not maintain them). The signs and symptoms of psychopathy are more complex and are an almost equal blend of the conduct and interpersonal/affective aspects of functioning. The two higher-order factors of the PCL-R reflect this blend. Factor 1, Interpersonal/Affective, includes signs such as superficial charm, pathological lying, manipulation, grandiosity, lack of remorse and empathy, and shallow affect. Factor 2, Lifestyle/Antisocial, includes thrill seeking, impulsivity, irresponsibility, varied criminal activity, and disinhibited behavior (Hare & Neumann, 2008). Psychopathy can be regarded as the most severe of the three disorders. Patients with psychopathy would be expected to also meet criteria for ASPD or dissocial personality disorder, but not everyone diagnosed with ASPD or dissocial personality disorder will have psychopathy (Hare, 1996; Ogloff, 2006). As noted by Ogloff (2006), the distinctions among the three antisocial conceptualizations are such that findings based on one diagnostic group are not necessarily applicable to the others and produce different prevalence rates in justice-involved populations. Adding a further layer of complexity, therapists will encounter patients who possess a mixture of features from all three diagnostic systems rather than a prototypical presentation of any one disorder.

Marco, remember early on when we discussed your frustration, and you determined that it was the defender part that wanted you to get back into the game of life? And that your anxiety was your fear-based defender part that was alerting you of the impending doom if you slipped and went back to your inappropriate behaviors? Or how about when the depression part stepped in, and you resolved that it was a reminder of your past actions? These are the physical symptoms of the defender parts.” I felt that if a light bulb was hanging over my head, it had now lit up. I was impressed with Keith’s memory of what I had said and the affection in his tone. At this moment, I trusted my therapist implicitly— he was the real deal. “Marco, identifying the defender part’s physical symptoms first is key to acknowledging when that part is coming in to control a situation or thought and identifying which one it is. Catching the defender part at this point is crucial to prevent it from starting to control the situation in an unhealthy manner or overwhelming your emotions with negative judgments.

The British Association of Art Therapists defines art therapy as: ...a form of psychotherapy that uses art media as its primary mode of communication. It is practised by qualified, registered Art Therapists who work with children, young people, adults and the elderly.[4] Clients who can use art therapy may have a wide range of difficulties, disabilities or diagnoses. These include, for example, emotional, behavioral or mental health problems, learning or physical disabilities, life-limiting conditions, brain-injury or neurological conditions and physical illness.

Touching Like nodding, touching shows interest. Upon meeting someone, the best way to show respect and sincere interest is to shake hands. A warm, firm handshake shows that you have an open, friendly social attitude. Don’t be afraid to be the first to smile, offer your name, and extend your hand—people will appreciate your interest and willingness to connect. With whom should you shake hands? These days, it’s appropriate to shake hands man to man, woman to woman, or man to woman—in both social and business contexts while exchanging names with other people. (Of course, a man should use a slightly gentler grip when shaking a woman’s hand.) A number of clients who have come to me say that their previous therapists or their parents have advised them to take a dance class in order to gain interactive skills and desensitize themselves to social anxiety. That’s a good idea. But it’s not that simple. The ideal situation would be one in which you could progress through the various levels of intimacy at a natural pace in an actual interactive situation. Developing a keen sense of interactive chemistry will help you to understand what type of touching behavior is appropriate. As for other, more personal forms of touch, these should be undertaken more cautiously, and with keen attention to the body language of the other person. When it seems appropriate, gestures such as taking someone’s arm or offering your own as you enter or leave a room or cross the street, touching a companion’s back as you introduce him or her to an acquaintance—all of these are fairly noncommittal, but are a display of caring and interest. When you try these things, take special note of the response you get. Remember that body language involves communication between two people. Not only do you need to give signals of friendliness and approval but also to take cues from the other person involved.

Behavioral marital therapy is a relatively brief treatment in which the therapist meets regularly with the depressed person and his or her partner. In the first phase of treatment, the therapist tackles the biggest strains on the relationship and helps the couple have more positive interactions. The couple may be given a homework assignment to figure out what activity they have enjoyed doing together in the past and then going ahead and doing it. When this phase is successful, the depressed person is already feeling brighter and both partners are expressing positive feelings toward each other. This boost serves as the foundation for the second phase, whose aim it is to restructure the relationship—for example, to improve the way that the couple communicates, handles problems, and interacts on a daily basis. Sometimes this is done by having the couple write a behavioral “contract,” agreeing to change aspects of their behavior. When successful, this phase will leave the couple feeling more supportive and sensitive to each other’s needs, more intimate, and better able to cope with future difficulties. Finally, in the third phase, the therapist helps the two partners prepare for stressful situations that might come to pass and encourages them to attribute their improvement in therapy to their love and caring for each other. Interestingly, behavioral marital therapy has been found to be at least as effective as individual therapy at lifting depression. However, it has the additional benefit of bolstering marital satisfaction. Indeed, a number of studies have shown that the boost in marital happiness (or favorable changes in the marriage related to that boost) is in fact the reason that the marital therapy works.

As a couples therapist, I have three sources of information: what the partners report about themselves and each other, how they behave in front of me, and how I feel witnessing their behavior.

What If I Love Someone With a Serious Trauma History? This is seriously tough, isn’t it? You have someone that you care about so much that is really struggling with their trauma recovery. You want to HELP. And feeling unable to do so is the worst feeling in the world. You’re at risk of serious burnout and secondary traumatization. Because yeah, watching someone live out their trauma can be a traumatic experience in and of itself. Two things to remember, here: This is not your battle. …but people do get better in supportive relationships. This is not your battle. You don’t get to design the parameters, you don’t get to determine what makes something better, what makes something worse. No matter how well you know someone, you don’t know their inner processes. They may not even know their inner processes. If you know someone well, you may know a lot. But you aren’t the one operating that life. Telling someone what they should be doing, feeling, or thinking, won’t help. Even if you are right. Even if they do what you say…you have just taken away their power to do the work they need to do to take charge of their life. There are limits to how much better they can really be if they are continually rescued by you. …but people do get better in supportive relationships. The best thing to do is to ask your loved one how to best support them when they are struggling. This is the type of action plan you can create with a therapist (if either or both of you are seeing one) or ask them in a private conversation. Ask them. Ask if they want help grounding when they are triggered, if they need time alone, a hot bath, a mug of tea. Ask what you can do and do those things, if they are healthy things to provide. It may be helpful for them to have a formal safety plan for themselves (there are resources for sample safety plans at the end of this book), with what your specific role will be. This will help boundary your role, and keep you from setting up scenarios when you rescue or enable dangerous and/or self-sabotaging behavior. You may need to set hard limits. You may need to protect yourself. This isn’t just for your well-being, but will help you model the importance of doing so to your loved one. Love the entirety of them. Remind them that their trauma doesn’t define them. Allow them consequences of their behavior and celebrate the successes of newer, healthier ways of being. Be the relationship that helps the healing journey.

I felt comfortable letting him correct my behavior, but I also felt okay pushing back on him and telling him when he was being too much. — At my second session, I brought up the fact that he was entirely different from the therapists I’d seen before. “It’s because I hated being the patient of therapists like that,” he admitted. “It terrified me. It didn’t ever make me feel safe. You have to be aware of how big a power difference there is between patient and therapist. And if you really want to work effectively with people, you have to keep surrendering your power. And that means being humble and making mistakes and fumbling and being comfortable with that.

When man is less than fully man—when he denies to awareness various aspects of his experience—then indeed we have all too often reason to fear him and his behavior, as the present world situation testifies. But when he is most fully man, when he is his complete organism, when awareness of experience, that peculiarly human attribute, is most fully operating, then he is to be trusted, then his behavior is constructive. It is not always conventional. It will not always be conforming. It will be individualized. But it will also be socialized.

Below the level of the problem situation about which the individual is complaining—behind the trouble with studies, or wife, or employer, or with his own uncontrollable or bizarre behavior, or with his frightening feelings, lies one central search. It seems to me that at bottom each person is asking, “Who am I, really? How can I get in touch with this real self, underlying all my surface behavior? How can I become myself?

The machine takes all of these multitudinous pulls and forces which are fed in as data, and quickly computes the course of action which would be the most economical vector of need satisfaction in this existential situation. This is the behavior of our hypothetical person. The defects which in most of us make this process untrustworthy are the inclusion of information which does not belong to this present situation, or the exclusion of information which does. It is when memories and previous learnings are fed into the computations as if they were this reality, and not memories and learnings, that erroneous behavioral answers arise. Or when certain threatening experiences are inhibited from awareness, and hence are withheld from the computation or fed into it in distorted form, this too produces error. But our hypothetical person would find his organism thoroughly trustworthy, because all of the available data would be used, and it would be present in accurate rather than distorted form. Hence his behavior would come as close as possible to satisfying all his needs—for enhancement, for affiliation with others, and the like.

My therapist helped me realize that I was more than my bad decisions or disrespectful language, and I knew that I wanted to be like her when I grew up. I

For those who are doing distance therapy, we are missing essential data and cues that were previously available to us: a client’s posture, scent, what the hands and feet are doing, where the person sits in the room, or who else is listening to the session. In addition, some of the most crucial parts of therapeutic change used to take place during the commute to and from sessions when clients would review and rehearse what they wanted to talk about, as well as the kaleidoscope of thoughts, feelings, and reactions that took place on the trip home

Some of the prominent ones that have been particularly useful for many trauma survivors include dialectical behavior therapy for borderline personality (Linehan, 1993); systems training for emotional predictability and problem solving (STEPPS; Blum et al., 2008; Bos, Van Wel, Appelo, & Verbraak, 2010 also for borderline personality; short-term psychodynamic treatment of affect phobia (McCullough et al., 2003); and mindfulness and mentalization-based treatments such as acceptance and commitment therapy (ACT; Follette & Pistorello, 2007). In the past decade, manuals that specifically address the

Anyone who has taken an introductory psychology course has likely encountered the developmental-stage models posited by Freud, Jung, Erikson, Piaget, and Maslow. But there’s one stage model I keep in mind nearly every minute of every session—the stages of change. If therapy is about guiding people from where they are now to where they’d like to be, we must always consider: How do humans actually change? In the 1980s, a psychologist named James Prochaska developed the transtheoretical model of behavior change (TTM) based on research showing that people generally don’t “just do it,” as Nike (or a new year’s resolution) might have it, but instead tend to move through a series of sequential stages that look like this: Stage 1: Pre-contemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Action Stage 5: Maintenance

In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are ego-dystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.

He’d given me permission to feel and also a reminder that, like so many people, I’d been mistaking feeling less for feeling better. The feelings are still there, though. They come out in unconscious behaviors, in an inability to sit still, in a mind that hungers for the next distraction, in a lack of appetite or a struggle to control one’s appetite, in a short-temperedness, or—

Your five-year-old son wanders around his kindergarten classroom distracting other kids. The teacher complains: he can’t sit through her scintillating lessons on the two sounds made by the letter e. When the teacher invites all the kids to sit with her on the rug for a song, he stares out the window, watching a squirrel dance along a branch. She’d like you to take him to be evaluated. And so you do. It’s a good school, and you want the teacher and the administration to like you. You take him to a pediatrician, who tells you it sounds like ADHD. You feel relief. At least you finally know what’s wrong. Commence the interventions, which will transform your son into the attentive student the teacher wants him to be. But obtaining a diagnosis for your kid is not a neutral act. It’s not nothing for a kid to grow up believing there’s something wrong with his brain. Even mental health professionals are more likely to interpret ordinary patient behavior as pathological if they are briefed on the patient’s diagnosis.[15] “A diagnosis is saying that a person does not only have a problem, but is sick,” Dr. Linden said. “One of the side effects that we see is that people learn how difficult their situation is. They didn’t think that before. It’s demoralization.” Nor does our noble societal quest to destigmatize mental illness inoculate an adolescent against the determinism that befalls him—the awareness of a limitation—once the diagnosis is made. Even if Mom has dressed it in happy talk, he gets the gist. He’s been pronounced learning disabled by an occupational therapist and neurodivergent by a neuropsychologist. He no longer has the option to stop being lazy. His sense of efficacy, diminished. A doctor’s official pronouncement means he cannot improve his circumstances on his own. Only science can fix him.[16] Identifying a significant problem is often the right thing to do. Friends who suffered with dyslexia for years have told me that discovering the name for their problem (and the corollary: that no, they weren’t stupid) delivered cascading relief. But I’ve also talked to parents who went diagnosis shopping—in one case, for a perfectly normal preschooler who wouldn’t listen to his mother. Sometimes, the boy would lash out or hit her. It took him forever to put on his shoes. Several neuropsychologists conducted evaluations and decided he was “within normal range.” But the parents kept searching, believing there must be some name for the child’s recalcitrance. They never suspected that, by purchasing a diagnosis, they might also be saddling their son with a new, negative understanding of himself. Bad

We learn how to accept feedback, tolerate discomfort, become aware of blind spots, and discover the impact of our histories and behaviors on ourselves and others.

Participants whose postures had been mimicked—even when they had not consciously noticed the mimicry—later reported having a more favorable impression of the person doing the imitation. Therapists know well that clients often rate their counselor more highly when the counselor has mimicked the client’s postures. And identification or a desire to affiliate with an individual increases the degree of behavioral mimicry.

The therapy thus starts by identifying negative appraisals, memories, trigger stimuli, and cognitive and behavioral factors that preserve symptoms. Then the therapist helps the client modify the excessive negative appraisals, elaborate the memories, discriminate triggers that lead to reexperiencing them, and eliminate cognitive and behavioral avoidance.